Muscle metaboreflex adaptations to exercise training in health and disease

Gama, Gabriel; Farinatti, Paulo; Rangel, Marcus Vinicius Dos Santos; Mira, Pedro Augusto de Carvalho; Laterza, Mateus Camaroti; Crisafulli, Antonio; Borges, Juliana Pereira

doi:10.1007/s00421-021-04756-8

Cited by 17 publications

(16 citation statements)

References 83 publications

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“…Beside direct myocardial dysfunction, autonomic imbalance and abnormal reflex regulation of the cardio-pulmonary system, i.e., muscle ergoreflex activity, contribute to muscle fatigue and breathlessness leading to exercise limitation. The ergoreflex, that combines metabo- and mechano-reflexes, is a cardiorespiratory reflex activated by exercise coupling ventilation and cardiovascular function to exercise intensity ( Alam and Smirk, 1937 ; Aimo et al, 2021 ; Gama et al, 2021 ). While the mechano-reflex is activated by mechanical stretching, the metaboreflex is activated by accumulation of metabolites in the exercising muscle humans, which are sensed by receptors in the muscle interstitial space and transmitted to the central nervous system via small non-myelinated group IV C fibers ( Crisafulli, 2017 ; Aimo et al, 2021 ; Gama et al, 2021 ; Teixeira and Vianna, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

“…The ergoreflex, that combines metabo- and mechano-reflexes, is a cardiorespiratory reflex activated by exercise coupling ventilation and cardiovascular function to exercise intensity ( Alam and Smirk, 1937 ; Aimo et al, 2021 ; Gama et al, 2021 ). While the mechano-reflex is activated by mechanical stretching, the metaboreflex is activated by accumulation of metabolites in the exercising muscle humans, which are sensed by receptors in the muscle interstitial space and transmitted to the central nervous system via small non-myelinated group IV C fibers ( Crisafulli, 2017 ; Aimo et al, 2021 ; Gama et al, 2021 ; Teixeira and Vianna, 2022 ). In response to metaboreflex stimulation, several regions of the central nervous system are activated, ensuring an adequate cardiorespiratory response during exercise mainly through increased sympathetic outflow.…”

Section: Introductionmentioning

confidence: 99%

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The ventilatory component of the muscle metaboreflex is overstimulated in transthyretin cardiac amyloidosis patients with poor aerobic capacity

et al. 2023

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Background: The exercise pressor reflex, i.e., metabo- and mechano-reflex, partially regulates the control of ventilation and cardiovascular function during exercise. Abnormal exercise pressor reflex response has been associated with exaggerated ventilatory drive, sympathovagal imbalance and exercise limitation in chronic heart failure patients. Whether metaboreflex is over-activated and participate to poor aerobic capacity in patients with hereditary transthyretin cardiac amyloidosis (CA-TTR) is unknown.Methods: Twenty-two CA-TTR patients (aged 76 ± 7, 68% male) with the V122I (p.Val142Ile) transthyretin underwent a thorough evaluation including heart rate variability metrics, electrochemical skin conductance (ESC), physical function cardiopulmonary exercise testing, and muscle metaboreflex assessment. Eleven control subjects were chosen for muscle metaboreflex assessment.Results: Age-matched controls (n = 11) and CA-TTR patients (n = 22) had similar metaboreflex sensitivity for heart rate, stroke volume, cardiac index and mean systemic arterial pressure. Compared with age-matched controls, metaboreflex sensitivity for systemic vascular resistance (−18.64% ± 6.91% vs 3.14% ± 23.35%) and minute-ventilation responses (−9.65% ± 14.83% vs 11.84% ± 23.1%) was markedly increased in CA-TTR patients. Values of ESC displayed positive correlations with stroke volume (r = 0.53, p = 0.011) and cardiac index (r = 0.51, p = 0.015) components of metaboreflex sensitivity, an inverse correlation with systemic vascular resistance (r = −0.55, p = 0.008) and a trend with mean arterial (r = −0.42, p = 0.052) components of metaboreflex sensitivity. Peak aerobic capacity (peak VO2%) displayed an inverse correlation with the ventilation component of metaboreflex sensitivity (r = −0.62, p = 0.015).Conclusion: Consistent with the “muscle hypothesis” in heart failure, it is proposed that deterioration of skeletal muscle function in hereditary CA-TTR patients may activate muscle metaboreflex, leading to an increase in ventilation and sensation of breathlessness, the perception of fatigue, and overall sympathetic activation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The ventilatory component of the muscle metaboreflex is overstimulated in transthyretin cardiac amyloidosis patients with poor aerobic capacity

et al. 2023

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“…Exercise training seems to improve sympathetic activity control and/or abnormal cardiovascular responses to muscle metaboreflex activation in several chronic conditions [17][18][19][20]. Although very little information is available on the potential mechanisms by which exercise training favors the muscle metaboreflex, they seem to include a wide spectrum of adaptations, as increased muscle perfusion with lower metabolite accumulation, greater antioxidant capacity, and changes in the expression of receptors evoking metaboreflex (i.e., the transient receptor potential vanilloid receptor 1 -TRPv1) [21]. Individuals with impaired metaboreflex have deficiencies in one or more of those mechanisms, and therefore might be more responsive to exercise training than healthy individuals [21].…”

Section: Introductionmentioning

confidence: 99%

“…Although very little information is available on the potential mechanisms by which exercise training favors the muscle metaboreflex, they seem to include a wide spectrum of adaptations, as increased muscle perfusion with lower metabolite accumulation, greater antioxidant capacity, and changes in the expression of receptors evoking metaboreflex (i.e., the transient receptor potential vanilloid receptor 1 -TRPv1) [21]. Individuals with impaired metaboreflex have deficiencies in one or more of those mechanisms, and therefore might be more responsive to exercise training than healthy individuals [21]. This is the case of PLHIV, who often present lactic acidosis [22] and attenuated pressor response to metaboreceptor stimulation [23].…”

Section: Introductionmentioning

confidence: 99%

The effects of exercise training on autonomic and hemodynamic responses to muscle metaboreflex in people living with HIV/AIDS: A randomized clinical trial protocol

et al. 2022

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Background People living with HIV (PLHIV) present impaired muscle metaboreflex, which may lead to exercise intolerance and increased cardiovascular risk. The muscle metaboreflex adaptations to exercise training in these patients are unknown. The present study aims to investigate the effects of a supervised multimodal exercise training on hemodynamic and autonomic responses to muscle metaboreflex activation in PLHIV. Methods and design In this randomized clinical trial protocol, 42 PLHIV aged 30–50 years will be randomly assigned at a ratio of 1:1 into an intervention or a control group. The intervention group will perform exercise training (3x/week during 12 weeks) and the control group will remain physically inactive. A reference group composed of 21 HIV-uninfected individuals will be included. Primary outcomes will be blood pressure and heart rate variability indices assessed during resting, mental stress, and activation of muscle metaboreflex by a digital sphygmomanometer and a heart rate monitor; respectively. Mental stress will be induced by the Stroop Color-Word test and muscle metaboreflex will be activated through a post-exercise circulatory arrest (PECA) protocol, being the latter performed without and with the application of a capsaicin-based analgesic balm in the exercised limb. Secondary outcomes will be heart rate, peripheral vascular resistance, stroke volume, cardiac output, blood lactate, anthropometric markers and handgrip maximal voluntary contraction. The intervention and control groups of PLHIV will be evaluated at baseline and after the intervention, while the HIV-uninfected reference group only at baseline. Discussion The findings of the present study may help to elucidate the muscle metaboreflex adaptations to exercise training in PLHIV. Trial registration This study will be performed at University of Rio de Janeiro State following registration at ClinicalTrials.gov as NCT04512456 on August 13, 2020.

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“…In view of these premises and of the growing interest that KDs are gaining in an increasingly large audience of potential patients, this review aims to investigate two aspects that we believe are extremely relevant for individuals approaching this type of diet, namely (1) how much the ability to exercise is influenced by the different bioavailability of metabolic substrates seen during the KD, and in particular by the scarcity of glucose, which is the fuel used by the muscle to support many of the physical efforts, especially those of higher intensity and short duration [27], and ( 2) what kind of benefit we can expect from this type of diet on blood pressure, since pathophysiologically obesity, altered glucose metabolism, and altered blood pressure control are closely interconnected.…”

Section: Introductionmentioning

confidence: 99%

Ketogenic Diet, Physical Activity, and Hypertension—A Narrative Review

et al. 2021

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Several studies link cardiovascular diseases (CVD) with unhealthy lifestyles (unhealthy dietary habits, alcohol consumption, smoking, and low levels of physical activity). Therefore, the strong need for CVD prevention may be pursued through an improved control of CVD risk factors (impaired lipid and glycemic profiles, high blood pressure, and obesity), which is achievable through an overall intervention aimed to favor a healthy lifestyle. Focusing on diet, different recommendations emphasize the need to increase or avoid consumption of entire classes of food, with only partly known and only partly foreseeable consequences on the overall level of health. In recent years, the ketogenic diet (KD) has been proposed to be an effective lifestyle intervention for metabolic syndrome, and although the beneficial effects on weight loss and glucose metabolism seems to be well established, the effects of a prolonged KD on the ability to perform different types of exercise and the influence of KD on blood pressure (BP) levels, both in normotensives and in hypertensives, are not so well understood. The objective of this review is to analyze, on the basis of current evidence, the relationship between KD, regular physical activity, and BP.

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Muscle metaboreflex adaptations to exercise training in health and disease

Cited by 17 publications

References 83 publications

The ventilatory component of the muscle metaboreflex is overstimulated in transthyretin cardiac amyloidosis patients with poor aerobic capacity

The ventilatory component of the muscle metaboreflex is overstimulated in transthyretin cardiac amyloidosis patients with poor aerobic capacity

The effects of exercise training on autonomic and hemodynamic responses to muscle metaboreflex in people living with HIV/AIDS: A randomized clinical trial protocol

Ketogenic Diet, Physical Activity, and Hypertension—A Narrative Review

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